Exercise and Tendon Remodeling Mechanism

Tendons connect muscles to bones and transmit the force exerted by the corresponding muscle to the skeleton and, therefore, are key components for locomotion. They are responsive to mechanical factors, which are essential for cellular functioning, tendon development, homeostasis, and repairing. Mechanical signals are transduced via molecular signaling pathways which trigger tendon adaptive responses. Previous data have already shown that exercise training promotes physiological adaptive responses, such as morphological properties and biomechanical and biochemical adaptations

The Caloric Necessities of Critical Care Patients During the First Week of Admission

Introduction: The nutritional needs of critically ill patients have been the subject of intense controversy. In accordance with international guidelines, it is advocated to optimize a nutritional intake based on the following recommendation: 25-30 kcal/kg body weight per day. However, there still are authors who recommend permissive underfeeding in the first week of hospitalization. Nevertheless, energy expenditure (EE) and necessity are influenced by the catabolic phase of critical illness, which may vary over time on a patient and from patient to patient. Objective: The objective of this study is to assess if the energy needs of critically ill patients admitted in our intensive care unit (ICU) in the first week of hospitalization are in line with those recommended by the European Society for Clinical Nutrition and Metabolism (ESPEN) international guidelines. Methods: A prospective cross-sectional study was carried out from September to December 2019. The energy needs were evaluated by indirect calorimetry and by the Harris-Benedict equation. Stress variables were evaluated, namely, the type of pathology, hemodynamic support, sedation, temperature, sequential organ failure assessment (SOFA) score, and state at discharge. Results: Forty-six patients were included in this study, with an average energy expenditure by indirect calorimetry of 19.22 ± 4.67 kcal/kg/day. The energy expenditure was less than 20 kcal/kg/day in 63% of the measurements. The concordance rate did not show the relationship between the Harris-Benedict equation and the values of indirect calorimetry. Stress variables were analyzed, with the SOFA score as the only variable with values close to statistical significance. Conclusion: In our ICU, the energy needs of critically ill patients in the first week of hospitalization are lower than the intake recommended by the guidelines.info:eu-repo/semantics/publishedVersio

Percepção de efeitos adversos por adolescentes em um programa preventivo de saúde bucal, a base de clorexidina e fluoreto

OBJECTIVE: The objective of this study was to evaluate the incidence of adverse effects reported by adolescents following 14 days of use of a mouthrinse containing 0.05% NaF+0.12% chlorhexidine. METHODS: This double-blind study was developed as part of a randomized clinical trial. The adolescents enrolled to the study were randomly divided into two groups to use either: 0.05% NaF+0.12% chlorhexidine (G1, n=85) or 0.05% NaF (G2, n=85). Both groups used a 10mL solution of the mouthwash during 1 minute daily for 2 weeks under supervision. After that period, the subject's acceptance of taste was measured using a verbal descriptive scale (Labeled Magnitude Scale - LMS)11. Participants were also interviewed regarding the occurrence of possible adverse effects during treatment (temporary palate disorders, tooth staining or unpleasant taste). The proportional differences between the groups were tested using the chi-square test. RESULTS: Palate changes were reported by 26% of participants of each group; 17.7% of G1 and 32% of G2 reported an unpleasant taste (p = 0.062), while staining was reported by 55% of G1 and 68.9% of G2 (p = 0.117). Absenteeism rates were similar in both groups (G1= 2.58 ± 2.69; G2=2.81 ± 2.39), p=0.362. CONCLUSION: adherence was high in both groups and side effects reported by subjects were not perceived by them as being important. Since subjects' acceptance and compliance is fundamental to the success of an oral health program, chlorhexidine-fluoride could be a useful resource in a program of plaque control.OBJETIVO: Este estudo se propôs a calcular taxa de efeitos adversos após 14 dias de uso de solução de bochecho de NaF 0,05% + clorexidina 0,12% realizados por adolescentes. MÉTODOS: Este estudo duplo-cego foi desenvolvido como parte de um ensaio clínico randomizado. Os adolescentes foram divididos aleatoriamente em dois grupos: NaF 0,05% + clorexidina 0,12% (G1) ou NaF 0,05%, (G2) de 85 estudantes cada que bochecharam diariamente, 10mL de solução sob supervisão, durante 1 minuto, por 2 semanas. Após esse período, a aceitação dos participantes ao gosto das soluções foi avaliada através de uma escala descritiva verbal - (LMS)11. Os participantes foram entrevistados também quanto a possíveis efeitos adversos acontecidos durante tratamentos (desordens temporárias de paladar, manchamento dental e o gosto de soluções desagradáveis). As diferenças entre proporções em ambos os grupos foram testadas pelo teste do qui-quadrado. RESULTADOS: Alteração de paladar foi informada por 26% dos estudantes de cada grupo; 17,7% dos G1 e 32% do G2 notaram o gosto desagradável (p = 0,062); manchas foram observadas por 55% dos G1 e 68,9% dos G2 (p = 0,117) e, as taxas de absenteísmo foram semelhantes (G1 = 2,58±2,69; G2=2,81(2,39), p=0,362. CONCLUSÃO: A aderência dos participantes foi alta e os efeitos colaterais percebidos não pareceram importantes pelos adolescentes nos dois grupos. Implicação prática: porquanto a aceitação e aderência dos participantes são fundamentais para o sucesso de um programa de saúde bucal, a associação da clorexidina-fluoreto poderia ser um recurso adicional favorável dentro de um programa de controle de placa

Fotodermatoses Autoimunes Parte II - Manifestações Clínicas e Terapêutica

The autoimmune photodermatoses are a group of heterogeneous idiopathic dermatoses including five different clinical entities some potentially severe with great impact in patients’ quality of life. General photoprotection measures are sufficient for the treatment of patients with mild forms of disease. In severe disease the therapeutic options are still limited, reflecting the ill-defined physiopathological mechanisms. However recent advances in photoprotection field are contributing to a higher therapeutic success. In an era where photodermatology has been losing its importance, we propose to revise the clinical manifestations and therapeutic options of autoimmune photodermatoses. These are rare and challenging disorders concerning diagnostic and treatment that need a specialized approach by dermatologists.As fotodermatoses autoimunes constituem um grupo heterogéneo de dermatoses idiopáticas incluindo cinco entidades clinicamente distintas: erupção polimorfa à luz, prurigo actínico, hydroa vacciniforme, dermite actínica crónica e urticária solar. Algumas destas dermatoses são potencialmente graves e com grande impacto na qualidade de vida dos doentes. Várias medidas de fotoprotecção são suficientes para o tratamento de doentes com formas ligeiras. As opções terapêuticas actuais são limitadas em doentes com doença grave e refractária, reflectindo os mecanismos fisiopatológicos pouco clarificados. Ainda assim, avanços recentes na área da fotoprotecção têm contribuído para um maior sucesso terapêutico. Numa altura em que a área da fotodermatologia tem vindo a perder gradualmente o seu impacto, propomos rever as manifestações clínicas e abordagens terapêuticas actuais das fotodermatoses idiopáticas, entidades raras e que impõem desafios relevantes no seu diagnóstico e tratamento

Fotodermatoses Autoimunes Parte I - Fisiopatologia e Diagnóstico

The autoimmune photodermatoses are a group of heterogeneous idiopathic dermatoses physiopathologically characterized by underexplored immune mechanisms, usually involving an immune reaction against an unknown antigen. This group includes five different clinical entities – polymorphous light eruption, actinic prurigo, hydroa vacciniforme, chronic actinic dermatitis, solar urticaria - some potentially severe with great impact in patients’ quality of life. The pathogenesis of the autoimmune photodermatosis seems to be realated with the formation of photoallergens in response to sunlight. The hypersensibility mechanism varies between the different diseases. The diagnosis depends on the recognition of the clinical presentation. Phototests confirm the diagnosis and allow the determination of the responsible radiation and limiar dose of induction. In an era where photodermatology has been losing its importance, we propose to revise the pathogenesis and diagnosis of autoimmune photodermatoses.As fotodermatoses autoimunes constituem um grupo heterogéneo de dermatoses idiopáticas que têm na sua génese alterações imunológicas atualmente não completamente esclarecidas. Este grupo inclui cinco entidades clinicamente distintas - erupção polimorfa à luz, prurigo actínico, hydroa vacciniforme, dermite actínica crónica, urticária solar -, algumas potencialmente graves e com grande impacto na qualidade de vida dos doentes. A fisiopatologia das fotodermatoses autoimunes parece estar relacionada com a formação de fotoalergénios em respota à exposição solar. O mecanismo de reação de hipersensibilidade é variável entre as diferentes patologias. O diagnóstico das fotodermatoses autoimunes depende do reconhecimento das caraterísticas clínicas. A realização de fototestes permite a confirmação do diagnóstico e a determinação da radiação e dose limiar indutora. Numa altura em que a área da fotodermatologia tem vindo a perder gradualmente o seu impacto, propomos rever a fisiopatologia e abordagem diagnóstica atual das fotodermatoses autoimunes

Nutritional quality of breakfast consumed by the low-income population in Brazil : a nationwide cross-sectional survey

Objective: This study aimed to characterize the nutritional quality of breakfast consumed by the low-income Brazilian population. Methods: A cross-sectional study was conducted with a sample of 1547 low-income individuals attending 36 Community Restaurants (CRs) in Brazil. Food consumption was analyzed by the frequency of food groups presented in the 24 h recall for three days. The nutritional consumption consisted of the analysis of the total energetic value (TEV) and the macronutrients, fibers, monounsaturated fatty acids, saturated fatty acids, trans fatty acids, calcium, and sodium. The nutrients were evaluated considering the percentage of contribution concerning the daily recommendation of consumption. Results: Among the 4641 breakfasts expected to be consumed and reported, 17.2% (n = 797) of the consumers did not consume breakfast. Therefore, we analyzed the 3844 breakfasts. The analysis of food groups showed a high consumption of dairy and cereals, and low consumption of fruits, roots/tubers, and meat/eggs. The percentages of energy contribution of the macronutrients in the TEV were adequate for a balanced diet. The mean intake of monounsaturated fatty acids was low, and the contribution percentages of saturated fatty acids and trans fatty acids were within the recommendations. The mean fiber intake of the breakfast was low, agreeing with the result of low fruit consumption. Calcium intake covered 73.49% of that expected for this meal, and sodium intake was adequate in breakfast. Conclusion: The individuals studied consumed a nutritionally balanced breakfast. Although dairy was one of the most consumed groups, calcium consumption was low, indicating the need to consume higher portions of food sources of this nutrient

Breakfast characterization and consumption by low-income Brazilians : food identity and regional food

The study aimed to evaluate the breakfast (BF) of the Brazilian low-income population, analyzing cultural aspects, such as the habit of consuming regional foods and the BF food identity markers. This cross-sectional study used a sample of 1872 low-income Brazilians. For the food consumption analysis, three 24–hour dietary recalls were used. For the qualitative analysis of the BF, we used three classifications: standard, full, partial, and without BF. Also, BF was considered as regional when at least one regional food (contained in a predefined list of regional foods) was consumed. For the analysis of BF's food identity markers, we evaluated all food groups and their frequencies. Of the 5616 possible BF meals available for the three days of consumption, 17.3% were skipped, a low percentage. A total of 4642 BF examples were analyzed. Standard type BF was prevalent in all regions, and full BF was rarely consumed by participants. Women during the weekend skipped BF less often. Out of all five Brazilian regions, the ones with the highest consumption of regional foods were the Midwest (46.6%) and the South (45.9%). The highest frequency of consumed foods in BF were coffee with cow’s milk (or milk with coffee), added sugar, bread, and margarine, indicating that these are the identity markers of BF in the studied sample. Considering that the percentage of standard type BF was very high and that the consumption of added sugar and margarine was accentuated, actions to stimulate the intake of fresh fruits and foods in all meals are necessary, especially in the first meal of the day. There is a need for new proposals for actions and programs with the purpose of expanding access to healthy and adequate regional foods, especially to low-income families